As the dust settles on Paul Reid’s decision to quit the Health Service Executive at the end of this year, minds are already turning to the future of the organisation – and who will lead it.
It’s a delicate task, not least because of the pandemic and its aftermath.
Reid came into the job talking about improving the “financial grip” of the organisation, axing the number of managers and even voluntary redundancy packages – but also about improving morale.
Headcount and budgets have since grown. Costs took a back seat as, in the words of one healthcare veteran, money “flowed in like water”. It also had the effect of galvanising the HSE: the emergency overrode inertia built into its culture, raising morale as the public rallied to support frontline workers.
The next chief executive will have a markedly different set of challenges to Reid. For one, the financial tides are changing. Reid wrote to managers last week outlining “very real pressure” on government finances and “significant competing demands” for funding.
The single, existential challenge of the pandemic has been replaced by the drumbeat of turf wars, scandals and controversies that are the stock in trade of healthcare politics in Ireland.
The next chief executive must steel themselves for this, and a diet of adversarial media and Oireachtas engagements that go with it – not to mention carving a path for Sláintecare reforms like regionalisation, which will face resistance in the centralised HSE.
“Power doesn’t let go of power easily,” remarked one HSE source this week.
Reid was hired as a reformer, but also because he had experience of how “the system” works, as a senior civil servant and in a local authority. There is nothing to suggest that calculus has changed, which may count against a swashbuckling hire from the private sector.
Anne O’Connor, the departing chief operating officer, would have been favourite – but, having missed out when Reid was appointed, she is now gone. A shortlist of HSE staff might include Dr Colm Henry, chief clinical officer, but it is some time since a medic led the health service.
Chief financial officer Stephen Mulvaney, chief strategy officer Dean Sullivan and Covid chief Damien McCallion could all feature, as might Prof Mary Day, the incoming head of acute hospitals, or Liam Woods, the man she is replacing (he is heading up regionalisation).
But sources believe there is no standout internal candidate. Bernard Gloster, the head of Tusla, is a former HSE executive who has experience leading a statutory agency and he, or someone with a similar CV, could prevail.
Pay is another vexed issue. Reid’s salary (topping out at €420,000 in 2020) along with that of Robert Watt, proved a lightning rod for criticism and scrutiny. The search for a replacement for Reid comes amid a charged debate about public pay, and an application will have to be made to the Department of Public Expenditure soon, sources believe, if a lengthy appointment process is to be completed by the time he leaves in December.
Cutting the salary for the role would suggest Reid was overpaid; keeping it invites a first set of negative headlines for the new boss.
There’s no easy option – but the Opposition is guarded, suggesting nobody wants to be held responsible for a process that misfires or is seen to attract a less-than-top-level candidate.
Sinn Féin’s health spokesman David Cullinane says pay should be “looked at” and not increased, but that attracting someone able for the challenge is important.
Róisín Shortall, the Social Democrats co-leader, says there is a case for benchmarking it to other health services but the “priority must be to recruit a person who has the capacity and expertise to take on this exceptionally challenging role”.